Provider Demographics
NPI:1730133141
Name:KAIM, OLEG (MD)
Entity Type:Individual
Prefix:DR
First Name:OLEG
Middle Name:
Last Name:KAIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 ENGLE ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2418
Mailing Address - Country:US
Mailing Address - Phone:201-567-4488
Mailing Address - Fax:201-567-4771
Practice Address - Street 1:214 ENGLE ST
Practice Address - Street 2:SUITE 11
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2418
Practice Address - Country:US
Practice Address - Phone:201-567-4488
Practice Address - Fax:201-567-4771
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06193500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6651208Medicaid
NJ6651208Medicaid
NJKA804566Medicare PIN
G19620Medicare UPIN